The .Plan

I.

When Bone Thugs-n-Harmony aren’t rapping about gunning down their rivals on St. Clair (C-Town, baby!), they’re busy offering paeans to ganja. “Fried Day” and “The Weed Song” are two such examples. Here is a sampling of the lyrics from “The Weed Song”:

And I just been smokin’ and smokin’
Smoke another blunt, roll another up
You know that weed can really ease your mind
Every time I smoke a reefer that indo high makes me fly
If everybody smoked a blunt, relieve the mind, the world could be a better place
If everybody took a break and we all just got wasted
Float out (out, out out), smoked out (out, out, out), choked out (out, out, out), pull another O (out, out, out)
Let’s get P-O-D-ded (P-O-D-ded, P-O-D-ded)

The words “fried day” have taken on a new meaning for me as I wind up the last few days of my internship. “Fried day” is the day you don’t want to be on call. “Fried day” is when the idiots who had a transient ischemic attack on Monday decide at last to come to the hospital. “Fried day” is when all of the other ward services decide to call in their neurology consultation requests. “Fried day” is when all the toxicity that has been building up in me over the course of the preceding week finally declares itself. My patients are no longer my patients: they have become orange cones standing between me and the door.

II.

Four years ago, the Accreditation Council for Graduate Medical Education (ACGME) required residency training programs to restrict the work hours that housestaff worked. These new rules limited housestaff to working <80 hours per week (<30 hours for a given shift) and guaranteed 4 days off per month. Reducing work hours seems to have benefited housestaff: we get into fewer post-call motor vehicle accidents and experience fewer accidental needlestick injuries. And our patients also seem to benefit. We make fewer ICU errors, and overall outcomes appear to have improved with the passage of the work hour restrictions.

I never knew what the practice of medicine was like prior to the ACGME change, but if I had to guess I would say that the work hour restrictions have adversely affected patient care in ways that are not easily measured. That assertion clearly runs counter to the grain of recent scientific inquiry as cited above. My post-call days are the most miserable of days, because the morning is a frenzy of activity as I try to finish all of my work before being chased out of the hospital at 3:00PM. The post-call day is the worst day to leave the hospital early, because so much happens during the first 48 hours. And when you come into work on the post-post-call morning, you feel totally out of the loop.

That being said, it is kind of nice to be working only 80-90 hours a week instead of the previously customary 100-110.

That being said, my only request with respect to these intractable policy debates is that people call the policy jockeying for what it is: it’s a game of hot potato, and nobody wants to be caught holding the spud. There is a very simple and elegant solution to the work hours dilemma: hire more staff. I have no problem with being in the hospital for 36 hours straight. But it’s just kind of hard to do that every 4 nights. If hospitals would simply hire more staff so that the call schedule could be stretched to every 6th or 7th night, then I suspect one wouldn’t hear so much whining from interns about work hours and patient safety.

But hiring more staff would introduce more slack into the system, and when you are in a perpetual financial crisis, then slack = bad.

III.

There are way too many entitled cyclists living in Seattle. On Fried Day, with my toxicity levels at their peak, I got into a shouting match with one of them. I attempted to pass (unsafely) twice, and my actions of course made her very aware of my presence. Yet she continued to refuse to use the bike lane and insisted on continuing along at 15 miles per hour.

IV.

This morning, we prayed the following prayer:

Dear Father,
we are thankful that your mercy is higher than the heavens,
  wider than our wanderings,
  deeper than all our sin.
Forgive our frivolous attitude toward life,
  our callousness toward suffering,
  and our envy of those who have more than we have.
Forgive our obsession with creating a life of constant pleasure,
  our indifference to the treasures of heaven,
  and our neglect of your wise and gracious law.
Help us change our way of life so that we may desire what is good,
  love what you love,
  and do what you command,
  through Jesus Christ our Lord.

So often our petitions and supplications are little more than “okay God, I goofed, but please don’t hold it against me. You’re not going to hold it against me, right?”

But our meditations ought to be more than that.

Help us change our way of life so that we may desire what is good,
  love what you love,
  and do what you command,
  through Jesus Christ our Lord.